Insulin regimes for 'new' T1Ds

[AJB_81]

Just looking for some thoughts about insulin regimes for new T1Ds... I'm certainly no expert but have learnt a bit in the last 10 years, so here's my quandary:
- Some unlucky people create antibodies which unfortunately attack the beta cells in their pancreas, we don't know why...
- The speed at which the beta cells are attacked and stop working is not well understood, however as the functionality of the pancreas reduces, through beta cell function loss, the body gets to a point were there isn't sufficient insulin produced to transfer glucose from the blood to cells. The cells are therefore not able to provide an energy source for the body. Hi glucose in our blood makes us thirsty, we drink and urinate a lot to try and flush our system of glucose.
- Independent to the accumulated glucose in our blood the body needs energy so it resorts to fat cells for this which results in rapid weight loss. Unfortunately this process creates ketones and if this continuos unnoticed can result in DKA (diabetic ketoacidosis) which can be fatal. This is often how T1D is found, as people get really poorly, or the signs of weight loss and thirst are spotted.
- When diagnosed we start on an insulin regime which 'bathes' our failing pancreas in insulin and kick starts a honeymoon...

So (apologies for the long scene setting but my point is coming next!) now in an exciting honeymoon phase we have a pancreas that functions to a greater or lesser extent, dependant on lost of things and we must begin a insulin treatment regime. Do we:
1) have purely basal insulin and manage a bit like a T2D as we wait for the inevitable decline of beta cells function as the nasty antibodies do their work, or do we
2) have less basal but bolus with meals to keep BGs more normal, basically straight on MDD (multiple daily injections)

I've read that the honeymoon can be extending by keeping BGs as close to normal as possible. My plan is to minimise basal, but ensure fasting bloods are good (which they are), and have as much bolus as I can (whilst avoiding hypos, 1 unit:25gs has worked all year) to prevent straining my poor pancreas and having high BG excursions post meals - both of which it has been suggested speed up killing off of the beta cells. I've worn a few Libre sensors and trends are excellent. If I had purely basal I would expect large BG spikes at meals, which I've read we should avoid, if possible. Keeping carbs at a reasonable level also helps, I try not to exceed 75g at each meal / day - I'm certainly not a LCHF dieter, I'm not sold on this approach yet...

Does anyone else follow my strategy, or am I missing something? I know we are all different but just interested to see what others think.

T1D is really what you make it, my diet has never been so good and I've never exercised as much as I have since diagnosis - keep a positive mind and T1D doesn't have to be all bad.

My wife has been T1D since 4 yo so I know the challenges I face when my beta cells are no more...

 

[Bluey1]

You are correct, the cause and the process of becoming diabetic is currently poorly understood. To complicate it further although the Pancreas is defective, the liver, what we eat hence the digestive tract all come into play. Even the brain has an influence. My specialist said when I was diagnosed there are multiple autoimmune attacks, the common one being detected with GAD antibodies. Therefore this becomes more complex. Some have no honeymoon and a few have a very long honeymoon. Your logic is sound, however biology doesn't necessarily follow logic.

Your attitude and approach is great, so just hang on for the ride and it will be what it will be. Apart from one or two posters here (they are only happy when they are miserable and even happier if they can make others miserable), everyone is just getting on with life. If you had to pick a proper disease, I think I would choose D everytime. There are some pretty awful and debilitating diseases out there, even people starving, I would suggest are far worse off and there are 100's of millions of them, even people living on the streets.

 

[Australia 1]

Just looking for some thoughts about insulin regimes for new T1Ds... I'm certainly no expert but have learnt a bit in the last 10 years, so here's my quandary:
- Some unlucky people create antibodies which unfortunately attack the beta cells in their pancreas, we don't know why...
- The speed at which the beta cells are attacked and stop working is not well understood, however as the functionality of the pancreas reduces, through beta cell function loss, the body gets to a point were there isn't sufficient insulin produced to transfer glucose from the blood to cells. The cells are therefore not able to provide an energy source for the body. Hi glucose in our blood makes us thirsty, we drink and urinate a lot to try and flush our system of glucose.
- Independent to the accumulated glucose in our blood the body needs energy so it resorts to fat cells for this which results in rapid weight loss. Unfortunately this process creates ketones and if this continuos unnoticed can result in DKA (diabetic ketoacidosis) which can be fatal. This is often how T1D is found, as people get really poorly, or the signs of weight loss and thirst are spotted.
- When diagnosed we start on an insulin regime which 'bathes' our failing pancreas in insulin and kick starts a honeymoon...

So (apologies for the long scene setting but my point is coming next!) now in an exciting honeymoon phase we have a pancreas that functions to a greater or lesser extent, dependant on lost of things and we must begin a insulin treatment regime. Do we:
1) have purely basal insulin and manage a bit like a T2D as we wait for the inevitable decline of beta cells function as the nasty antibodies do their work, or do we
2) have less basal but bolus with meals to keep BGs more normal, basically straight on MDD (multiple daily injections)

I've read that the honeymoon can be extending by keeping BGs as close to normal as possible. My plan is to minimise basal, but ensure fasting bloods are good (which they are), and have as much bolus as I can (whilst avoiding hypos, 1 unit:25gs has worked all year) to prevent straining my poor pancreas and having high BG excursions post meals - both of which it has been suggested speed up killing off of the beta cells. I've worn a few Libre sensors and trends are excellent. If I had purely basal I would expect large BG spikes at meals, which I've read we should avoid, if possible. Keeping carbs at a reasonable level also helps, I try not to exceed 75g at each meal / day - I'm certainly not a LCHF dieter, I'm not sold on this approach yet...

Does anyone else follow my strategy, or am I missing something? I know we are all different but just interested to see what others think.

T1D is really what you make it, my diet has never been so good and I've never exercised as much as I have since diagnosis - keep a positive mind and T1D doesn't have to be all bad.

My wife has been T1D since 4 yo so I know the challenges I face when my beta cells are no more...

This was the one of the most informative writings that answered many many questions. The Honeymoon Issue Just needs to be Clarified a bit more. Thank you for that word of life for me.

 

[AJB_81]

You are correct, the cause and the process of becoming diabetic is currently poorly understood. To complicate it further although the Pancreas is defective, the liver, what we eat hence the digestive tract all come into play. Even the brain has an influence. My specialist said when I was diagnosed there are multiple autoimmune attacks, the common one being detected with GAD antibodies. Therefore this becomes more complex. Some have no honeymoon and a few have a very long honeymoon. Your logic is sound, however biology doesn't necessarily follow logic.

Your attitude and approach is great, so just hang on for the ride and it will be what it will be. Apart from one or two posters here (they are only happy when they are miserable and even happier if they can make others miserable), everyone is just getting on with life. If you had to pick a proper disease, I think I would choose D everytime. There are some pretty awful and debilitating diseases out there, even people starving, I would suggest are far worse off and there are 100's of millions of them, even people living on the streets.

Thanks for your thoughts. At diagnosis I was tested for a few different anti bodies as I was involved in some research with Address-2. This confirmed T1 as it seemed very surreal having lived with the condition with a T1D wife. I'd been through the change to 5 injections a day, to pump therapy, learn't DAFNE with her to all of a sudden end up with it myself! OMG! What are the chances!
Anyway, as you say it could be lots worse!

I guess I just find it fascinating that the treatment for newly diagnosed can vary, some just basal, and also concerned by the number of people wrongly diagnosed with T2 in the begging when early T1 diagnosis would save lots of pain. I had a bad experience with a few health professionals at diagnosis who didn't like the fact I new a bit about T1D as I had learnt as much as I could to help my better half. It wasn't a competition but was upset/amazed by some GPs lack of knowledge. Because the knowledge gap is widespread it's probably a systematic educational flaw somewhere? Anyway, I don't want to sound like a negative person, as you hint at above - enough of these about already

 

[Bluey1]

I had a bad experience with a few health professionals at diagnosis who didn't like the fact I new a bit about T1D as I had learnt as much as I could to help my better half. It wasn't a competition but was upset/amazed by some GPs lack of knowledge.

There are some very average Health professionals out there and amazingly good ones. "Birds of a feather stick together" really applies. Get a really good one, GP Nurse etc and they will connect you with the rest. My team is amazing everyone of them. I have come across a few shockers in my time.

 

[Big_Col]

I'll comment on new Insulin regimes. I'm on Humulin I & S. Find keeping on an even keel incredibly easy.

Knowing people on newer 'better' regimes having so much trouble I'm glad I'm old school.

 

[Bertyboy]

I have a friend who is a GP and she fully admits that there is a chasm between what she was taught about diabetes on her degree and as an F1 and what is the current research (she is now doing a course to bring her up to date). It shows that the medical profession are generally behind on understanding type 1 and the best reaction to it. Interestingly, she has encountered type 1 patients who have "reversed" their diabetes. This is either misdiagnosis or a genuinely interesting area for research.
Personally, I am not convinced about my diagnosis of 4 months ago, because I don't have the GAD indicators. I suspect I have insulin resistance that came on very quickly which lead to the high ketones. As I managed to get my HbA1C down from 152 to 40 in that time, I'm going to carry on with dual insulin but try and decrease both as things normalise. I wonder if giving the pancreas a bit of a holiday is all that is needed...

 

[AJB_81]

I have a friend who is a GP and she fully admits that there is a chasm between what she was taught about diabetes on her degree and as an F1 and what is the current research (she is now doing a course to bring her up to date). It shows that the medical profession are generally behind on understanding type 1 and the best reaction to it. Interestingly, she has encountered type 1 patients who have "reversed" their diabetes. This is either misdiagnosis or a genuinely interesting area for research.
Personally, I am not convinced about my diagnosis of 4 months ago, because I don't have the GAD indicators. I suspect I have insulin resistance that came on very quickly which lead to the high ketones. As I managed to get my HbA1C down from 152 to 40 in that time, I'm going to carry on with dual insulin but try and decrease both as things normalise. I wonder if giving the pancreas a bit of a holiday is all that is needed...

I can see why you'd be suspicious of being T1D if you're not showing +I've for GADs, however I think there are a few other antibody types that can kill beta cells, I don't think GAD is the only one but the most common. It would be good if you could be tested for the others too. My thoughts on this are that you are describing the honeymoon effect. If we are diagnosed with type 1 through identification of the nasty antibodies the clocks ticking to being fully dependant on insulin - I believe it's impossible to reverse or cure, we just get a nice honeymoon to enjoy (or some do!)
As I started injecting insulin I started to have hypos and slowly backed off to the point where I could quite easily have managed without. I read quite a few examples of others finding this too, and some believing they were cured. I have made my own conclusion that I am going to avoid a denial phase and continue to assist my failing pancreas as much as I can with additional insulin to hopefully prolong my honeymoon. With a wife who's been T1 since a child I know exactly what is in store when fully blown T1.
Good to chat - thanks!

 

[Robinredbreast]

Thanks for your thoughts. At diagnosis I was tested for a few different anti bodies as I was involved in some research with Address-2. This confirmed T1 as it seemed very surreal having lived with the condition with a T1D wife. I'd been through the change to 5 injections a day, to pump therapy, learn't DAFNE with her to all of a sudden end up with it myself! OMG! What are the chances!
Anyway, as you say it could be lots worse!

I guess I just find it fascinating that the treatment for newly diagnosed can vary, some just basal, and also concerned by the number of people wrongly diagnosed with T2 in the begging when early T1 diagnosis would save lots of pain. I had a bad experience with a few health professionals at diagnosis who didn't like the fact I new a bit about T1D as I had learnt as much as I could to help my better half. It wasn't a competition but was upset/amazed by some GPs lack of knowledge. Because the knowledge gap is widespread it's probably a systematic educational flaw somewhere? Anyway, I don't want to sound like a negative person, as you hint at above - enough of these about already

I never had a honeymoon period ( it wasn't even mentioned to me in hospital) and this is my 29th year.

 

[db89]

I seem to have been more in line with scenario 2 since diagnosis. Once I had stabilised from DKA and my honeymoon began I found that both my basal and my bolus ratios decreased. I don't take a large dose of basal to keep me steady but I think I may need to reassess and start upping it as I am not staying as flat as I was when there was no bolus on board.

I ended up with three separate bolus ratios throughout the day (which changed again when I went from Novorapid to Fiasp) and have stayed reasonably the same since but also recently I am finding I am needing to correct more postprandial. Perhaps my honeymoon is just starting to fade.

 

[AJB_81]

I seem to have been more in line with scenario 2 since diagnosis. Once I had stabilised from DKA and my honeymoon began I found that both my basal and my bolus ratios decreased. I don't take a large dose of basal to keep me steady but I think I may need to reassess and start upping it as I am not staying as flat as I was when there was no bolus on board.

I ended up with three separate bolus ratios throughout the day (which changed again when I went from Novorapid to Fiasp) and have stayed reasonably the same since but also recently I am finding I am needing to correct more postprandial. Perhaps my honeymoon is just starting to fade.

I think scenario 2 should be the only scenario really - I find it strange some go for high basal and let the failing pancreas try and deal with the glucose thrown at it during a meal - I just don't really see why that advice is given. Better to get used to MDI as its only a matter of time.
Hope your honeymoon isn't over! Take care.